250076 Facility Characteristics and the Risk of Developing Pressure Ulcer in U.S. Nursing Homes

Monday, October 31, 2011: 11:24 AM

Yu Kang, PhD , Department of Public Health and Health Sciences, University of Michigan, Flint, Flint, MI
Hongdao Meng, MPH, PhD , College of Behavioral & Community Sciences, School of Aging Studies, University of South Florida, Tampa, FL
Kathryn Hyer, MPP, PhD , School of Aging Studies, University of South Florida, Tampa, FL
Prevention programs targeting nursing home-acquired pressure ulcers had limited success due to the complexities in several individual- and facility-level factors. We examined the impact of facility characteristics on nursing home-acquired pressure ulcers after controlling for individual risk factors. We studied 12,507 residents in 1,174 nursing homes from the 2004 National Nursing Home Survey. We used a multinomial logistic regression model to predict risk-adjusted probabilities of pressure ulcers with four stages. Among the 1,313 residents developed pressure ulcers, 326, 675, 133 and 179 were at stage I, II, III and IV accordingly. Ulcer diagnosis at admission substantially increased the odds of developing stage IV ulcers. Higher average ADLs per person, using bedrail and needing assistance in bed mobility were each associated with greater odds of developing ulcers at all stages. Medicaid coverage increased the odds, especially at more advanced stages; while insured by Medicare predicted slightly smaller odds of stage IV ulcers. Facilities with higher percentage of Medicaid or Medicare beneficiaries predicted greater odds of stage IV ulcers (OR 2.14, 95%CI[2.09,2.18] and OR 1.56, 95%CI[1.53,1.59]). A director of nursing on board reduced the odds of ulcers at stages I to III. Facilities offering clusters of beds for Alzheimer's disease or rehabilitation as well as special care programs for end-of-life, behavior problem, or skin wounds all reduced the odds of stage IV ulcers. Policy efforts to enhance Medicaid payment approaches and levels, as well as to provide special care programs will likely reduce nursing home acquired ulcers.

Learning Areas:
Public health or related public policy

Learning Objectives:
1. Describe the factors associated with nursing home acquired pressure ulcers, analyzing these factors at both individual- and facility- levels. 2. Discuss the policy implications of the findings on facility quality improvement and on design of special care programs.

Keywords: Nursing Homes, Quality of Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the leading author in this research and this manuscript.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.